Monday, June 13th, 2016

Coming Out as a Psychiatrist

Andrew Cruz, MD

I imagine many people feel the same way I do–that they don’t quite fit in. As an adolescent, I was more sensitive than a lot of the other boys. I found myself enjoying the piano repertoire and theatre more than football and chasing girls. I know now, as an adult, that the aforementioned are just ignorant stereotypes, but kids don’t know the word “stereotype.” All they know is that their truth doesn’t harmonize with their surroundings. I learned early on, to adapt to my environment. To call it survival—might sound dramatic, but for teenaged me it was. I had endured enough teasing and taunting in elementary and middle school that I felt it necessary to embrace all those things I didn’t really enjoy in order to be liked and, ultimately, happy. I lost weight the summer between middle school and high school and my braces came off. I became prom king, basketball team captain, and started dating a sweet girl at my small school but (spoiler alert) found no happiness.

I found myself in a similar situation early in my medical career. By this time, I was now proficient in conformity and had become complacent because, as I logicized to myself, as long as everyone else around me was happy with me, even though I was not, the net sum of happiness was acceptable. I had continued to try to find my worth in popularity and achievements. I was president of many organizations and was doing well in school but I was miserable. I had been putting so much energy into “surviving” that I took until I was around 26 years old to finally accept that I am gay. I had managed to suppress a thought which should have been obvious to me.  Desperately, one evening I sat at my computer and began typing a Facebook post, of all things: “I’m Gay…” I barely remember the next few days. The responses were overwhelmingly positive but those that were angry, hateful, and ignorant seemed to come from the people who matter the most. There were many tears and hugs per hour during those days. The dust eventually settled and I could see clearly. It sounds absurd, but I swear that the sky was a little bluer, food tasted a little better, and every interaction meant a little more.

When we find ourselves spending a majority of our lives pretending, the day we decide not to anymore can feel like standing on the precipice of a revolution–and IT IS. But things do not change overnight. The defense mechanisms that we learn as children become habits. I found myself still wanting to achieve and to be liked.  During my third year of medical school, I knew from the moment I started seeing psychiatric patients that I wanted to spend my life making sure every single one of them knew how much they mattered. I wanted to make their skies bluer. Even though I had no psychosis, I felt that I could empathize with their struggles because I, too, was fighting. When I expressed my interests in psychiatry I was taken aback by the lack of support. “Psychiatry is a pseudoscience” (evidence is to the contrary).  “It’s all in their head” (well, kind of, but only because your brain is in your skull). “You won’t make any money” (I don’t care). The words didn’t bother me, what bothered me was that, there I was, again, isolated and alone and not quite fitting in. The same stigma that I had already once felt was presenting itself again in my life. I quickly adjusted and expressed an interest in surgery. I found the support and acceptance I was looking for, but again, no happiness.

Three months into surgery residency, in the Chair of Surgery’s office I tearfully pleaded my case. I explained my reasoning, my mistakes, and my hope that in becoming a psychiatrist I would find joy and be able to translate that it into changing the world of each of my patients. My program director and chair were agreeable and I reapplied for residency. Colleagues, confidants, and family had their doubts but I knew that I needed to make this change.  I decided that instead of taking pride in being a surgeon or what others think, I was going to start taking pride in my happiness. I came out, again; this time as a psychiatrist.

How many people out there are in the closet? The law student who has always dreamed of attending culinary school. The son who cannot bring himself to tell his devout family that he has fallen in love with an atheist. The spiteful husband who has never spoken about his childhood trauma. The broken and depressed teenager who hasn’t told anybody about her feelings because she is afraid no one cares. The functional alcoholic who feels that his problem is not disease, but absence of discipline. The suicidal grandfather who feels he will be doing his family a favor. In these people I see patients whom I have a desire to treat, but even more I see a narrative that binds me to them, that binds all of us to them, and whether it is stigma about mental illness or homosexuality, it does nothing but weaken that bond.

Maybe everyone has a closet and maybe everyone should come out.

The truth is, that it is not about net happiness; it is about your happiness. The truth is, that it matters a whole lot less that you blended in with everyone as much as that you affected them. The truth is, that your truth should be a source of pride and not fear. The truth is, that every tear and every struggle has brought you a little closer to opening your closet.  The truth is, that pretending takes a whole lot of energy and there are a lot of victims, homeless, starving children, and ill individuals that would be better served by that energy. I believe that we all, mostly unintentionally, put out bad into the world and then spend our lives regretting our mistakes. What if we used the energy found in accepting our true selves to put out just enough good into the world to make amends? We could change things. We could change the world.

One can convince himself or herself that they have a more difficult life or that their closet is a little messier than someone else’s, but that is missing the point. The point is that everyone has a life and everyone has a closet. We share those entities with all of humanity and we struggle with them all the same. United in that struggle, regardless of where you come from or what you have been through, we ALL fit in.


About Andrew (Andy) Cruz, MD

Andrew Cruz headshotAndrew (Andy) Cruz is a psychiatry resident, classically trained concert pianist, composer, and writer. He was born and raised in Amarillo, Texas and attended undergraduate and graduate school at Texas Tech University. Andrew majored in Music with a concentration in Piano and earned a Graduate Certificate in Piano Pedagogy. He worked his way through school by being a campus tour guide, restaurant manager, bartender, and choir director. While in Medical School he served as president of his class, president of the Texas Tech University Health Sciences Center Gold Humanism honor society, and on the admissions committee. He graduate in May of 2015 and was honored to be able to address his class at the graduation ceremony. He is currently a resident at Massachusetts General Hospital/McLean/Harvard Medical School. Dr. Cruz aims to develop curricula for mental health education in the nation’s school systems and to increase access to mental health care for all populations, especially the indigent and uninsured, and to decrease stigma associated with psychiatric pathologies.  You can contact Dr. Cruz on Twitter @openheartpsych or by email All of Dr. Cruz’s views are personal and not those of his institution.

8 thoughts on “Coming Out as a Psychiatrist

  1. Kudos. My closet door has cracked a little. I am inspired. Late, but not too. Thanks, in so many ways.

  2. Dearest Andy,
    What an inspiration you are to me, as well as, anyone that is fortunate enough to read what I consider, your heart & soul..
    I had the privilege of meeting you when your dear friend Lucas, asked my daughter to marry him. At that time, I knew what a beautiful person you were!
    I wish you the very best in your pursuits, which I do mean that plural. Andy, you are so gifted, talented & I feel blessed being able to say, you are part of our family!

  3. Absolutely amazingly written – thank you for sharing. I have nothing by the greatest respect for Psychiatrists, having needed to be seen by many throughout my (albeit, currently rather limited) time at Medical School. The stigma associated with mental health and homosexuality is rubbish and shouldn’t exist. I’m sure you’ll go on to go very well in the future.

  4. As a Hispanic mother of a gay son, waiting admission to medical school, and a mental health professional myself, my heart goes out to you! Congratulations!

  5. Thank you for writing this and sharing your story. Your article was what I really needed to see today. This is the sign I have been looking for. Thank you so much once again.

  6. sooo nice
    I had the privilege of meeting you when your dear friend Lucas, asked my daughter to marry him. At that time, I knew what a beautiful person you were!

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